Kupeelu (कुपीलु)- NUX VOMICA – Static/Plant poison | Liveveda

Kupeelu - Nux Vomica

Introduction

It is an alkaloid obtained from the tree " Strychnos nux vomica" of family Loganiaceae. It grows well in South India and Bengal. Seeds are the most toxic part.

Synonyms

कुचिल, कुलेचक, कुचेल, विषतुन्द, विषमुष्टि, कारस्कर

Active principles

  1. Strychnine
  2. Brucine
  3. Loganine

Signs and Symptoms

The onset of symptoms depends upon the route. it is immediate when the form of poison is given by the injectable route. If the poison is given by the oral route it may take few minutes to one hour. The patient has first :

  1. A bitter taste in the mouth and a cocking sensation in the throat which leads to a sense of suffocation and difficulty in swallowing.
  2. The the patient becomes uneasy and restless followed by twitching in various parts of the body.
  3. Convulsions are evident after a short while.

During a fit of convulsion the face is cyanosed, eyes open and become staring type, the eye balls becomes slightly bulging and the pupils dilated.

4. The body may take one of the shapes due to the contract muscles :

  • Opisthonos - The body being arched on heels and head.
  • Emprosthotonos - The body being arched forward testing virtually on the knee and forehead.
  • Pleurosthonos - The body being arched laterally. This position is comparitively rare.

5. When the muscles of diaphragm are affected the patient feels a sense of suffocation due to respiratory distress. It also causes a severe epigastric pain

6. Reflex excitability is increased

7. vomiting is usually absent. Once it sets in it remains till death.

8. The prognosis of a case can be assessed by the duration and frequency of convulsions. Many of the feature of Strychnine poisoning resemble the clinical picture seen in case of tetanus.

Strychnine poisoning Tetanus
1. Circumstantial evidence 1. History of injury of poisoning
2. Sudden onset 2. Gradual onset
3. Trismus is a late feature 3. Usually begins with trismus
4. Relaxation of muscles in between convulsions 4. Sustained rigidity even between convulsions
5. Chemical analysis may reveal the poison 5. Chemical analysis yields nothing

Fatal Dose -

  • Nux vomica powder (Churna) - 2 gm
  • Strychnine : 15 - 30 mg.

Fatal period

The usual fetal period is 1-2 hrs.

Management/ Treatment

  1. Neuromuscular paralysis may have to be induced with succinyl choline to facilitate endotracheal intubation.
  2. Oxygen therapy.
  3. Convulsions - Diazepam or barbiturates
  4. Induction of emesis or stomach wash.
  5. Acidification of urine can significantly enhance the excretion of strychnine
  6. Treat the patient in a quiet, dark room with minimal external stimuli.

Post-mortem appearance

  1. Rigor mortis is rapid and persists for a longer time.
  2. Postmortem caloricity is sometimes encountered, i.e the body temperature shows a slight rise for a while after death instead of usual fall.
  3. Strychnine is said to be resist putrefaction and can be detected by chemical analysis long after death.
  4. Asphyxial signs are usually seen

Medico-legal Impotance

  1. It is sometimes used for homicide in the form of alkaloid, or as powdered nux vomica seeds, inspite of bitter taste.
  2. Suicide is rare because of the painful death.
  3. Accidental deaths are more common, due to an over-dose of medicinal preparation, or the poison being given by mistake, or in children by eating the seeds.
  4. The seeds are used for killing cattle and as arrow poison.
  5. In India nux vomica is taken as an aphrodisiac.

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